Obesity Ups Diabetes Risk Among Living Kidney Donors

The adjusted 5-year risk of insulin use following donation is 5 times higher among obese vs normal weight donors.

The following article is part of conference coverage from the 2017 American Transplant Congress (ATC) in Chicago, Illinois. Renal and Urology News' staff will be reporting breaking news associated with research conducted by leading experts in transplantation. Check back for the latest news from ATC 2017.

Overweight and obesity are associated with higher risks of new-onset diabetes mellitus among living kidney donors (LKD), data presented at the 2017 American Transplant Congress in Chicago suggest.

Krista L. Lentine, MD, PhD, Professor of Medicine at Saint Louis University (SLU) in Saint Louis, Missouri, and colleagues studied 20,138 LKD with at least 1 year of pre-donation pharmacy fill records. Of these, 67.5% were women, 75% were white, 10.5% were black, and 10.9% were Hispanic. The investigators examined pharmacy fills for insulin and non-insulin diabetes medications as measures of new-onset post-donation diabetes mellitus (PDDM).

At donation, the donors had a mean age of 42.7 years, and 40.8% were overweight (body mass index [BMI] of at least 25 but less than 30 kg/m2) and 22.8% were obese (BMI of 30 kg/m2 or higher).

The 5-year risk of non-insulin PDDM treatments increased in a graded manner with higher BMI, from 0.6% in normal weight donors to 1.5% and 3.4% in overweight and obese donors, respectively. In adjusted analyses, the 5-year risk was 3.0-fold and 6.4-fold higher among overweight and obese donors compared with normal weight donors. The adjusted 5-year risk of insulin use following donation was 1.1% among obese donors compared with 0.04% among normal weight donors. The adjusted 5-year risk of insulin use was 5-fold higher among obese than normal weight patients.

Once PDDM drugs were started, use of non-insulin agents and insulin continued over 99% and 30% of remaining observation time, according to the investigators.

“The implications of obesity for the acceptance of living donor candidates have been controversial” Dr Lentine, Medical Director for Living Kidney Donation at SLU's Center for Transplantation, told Renal & Urology News. “These data support that obesity is a strong predictor of PDDM treatments in LKD. Future research should define relationships of obesity and PDDM with hard outcomes including kidney failure after donation.”